Real doctors are ‘holistic’. Alternative practitioners are anything but

    28 October 2016

    One of the most common claims of alternative practitioners is that they take a holistic approach to healthcare. It is a claim which, to many consumers, sounds attractive. Intentionally or not, it makes conventional medicine look bad, reductionist and somewhat inhuman, implying that mainstream medicine is non-holistic. Yet all good medicine was, is and always will be holistic, and much of alternative medicine far less holistic than alternative practitioners try to make us believe.

    Let me try to explain what I mean by using the example of acupuncture. A recent trial of acupuncture for neck pain found that adding acupuncture to usual care generated a slightly better outcome than usual care alone. This is hardly a big deal: adding a placebo, a good cup of tea or a compassionate chat to usual care might have done a similar thing. Acupuncturists, however, will insist that it is their holistic approach which is successful.

    But is that true? How holistic is acupuncture?

    A ‘Western’ acupuncturist would normally ask his patient what is wrong with her; in the case of neck pain, he would probably ask several further questions about the history of the condition, when the pain occurs, what aggravates it etc. Then he might conduct a physical examination of his patient. Eventually, he would get out his needles and start the treatment.

    A ‘traditional’ acupuncturist might ask similar questions, feel the pulse, look at the tongue and make a diagnosis in terms of yin and yang imbalance. Eventually, he too would get out his needles and start the treatment.

    Is that holistic? Certainly not!

    If we look at alternative practitioners in more general terms, we cannot fail to notice that they tend to be the very opposite of holistic. They usually attribute a patient’s illness to one single cause such as yin/yang imbalance (acupuncture), subluxation (chiropractic), impediment of the life force (homeopathy), etc. And if one investigates what type of treatments are currently called ‘holistic’, one is bound to find that many or most are outright quackery. If you don’t believe me, please check online for yourself.

    Holistic care originally meant that the patient is understood as a whole person — body, mind and soul — and that all systems interact with other parts of the body. Our neck pain patient, for example, could have physical problems such as muscular tension; her acupuncturist might well have realised this and placed his needles accordingly. But neck pain, like most other symptoms, can have many other dimensions, for instance:

    • stress
    • an ergonomically disadvantageous work place
    • a history of injury
    • a malformation of the spine
    • a tumour
    • an inflammation
    • other specific diseases
    • relationship problems, etc etc.

    Of course, acupuncturists will insist that, during therapy, they will pick up on these possibilities. However, in my experience, this is little more than wishful thinking. And even if they were aware of the multitude of dimensions, what can they do about it? They can (and often do) give rather amateur advice. No doubt, this is meant kindly but it is rarely optimal.

    And what about conventional practitioners, aren’t they even worse when it comes to holistic care?

    As pointed out above, good medicine is holistic; but sadly, not all conventional medicine is good. Yet even a mediocre doctor would know that human illness tends to be multifactorial and therefore requires treatments that are multifactorial. Already at medical school, we learn that symptoms/complaints/conditions/diseases can have multiple causes, risk factors and contributing factors which can interact in complex ways. Therefore, responsible physicians always consider treating patients in multifactorial, multidisciplinary ways; in the case of our neck pain patient:

    • the stress might be alleviated with a relaxation programme
    • the workplace might need the input of an occupational therapist
    • in case of an old injury, a physiotherapist might be required
    • specific conditions might need to be seen by a range of medical specialists
    • muscular tension could be reduced by a massage therapist
    • relationship problems might require the help of a psychologist, etc, etc.

    I am not saying that all of this is necessary in each and every case. But I do insist that, in conventional medicine, both the awareness and the availability of a professional multidisciplinary approach is well established — much better than in the realm of alternative medicine. You don’t believe me? Ask a physiotherapist, occupational therapist or psychologist who refers more patients to them — an acupuncturist or a GP?

    Alternative practitioners claim to be holistic and some might be aware of the complexity of their patients’ symptoms. But, at best, they have an amateur approach to this complexity by issuing more or less adequate advice. The truth is that they are not properly trained to do this job, and they refer far less regularly than conventional physicians.

    Real doctors hesitate to think of their multidisciplinary approach as being ‘holistic’. Why? Because they tend to associate this term with the thinly disguised marketing ploys of charlatans.

    Edzard Ernst, emeritus professor at the University of Exeter, is the author of A Scientist in Wonderland and the awardee of the John Maddox Prize 2015 for standing up for science. He blogs at